PL CLAIM SPECIALIST

divh2Claim Specialist / h2pBy joining Sedgwick, youll be part of something truly meaningful. Its what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, theres no limit to what you can achieve. / ppPrimary Purpose : / ppTo analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and / or severe injury claims; to coordinate case management within company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. / ppEssential Functions and Responsibilities : / ppAnalyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. / ppConducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. / ppNegotiates claim settlement up to designated authority level. / ppCalculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. / ppRecommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. / ppCoordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. / ppUses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. / ppIdentifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. / ppRepresents company in depositions, mediations, and trial monitoring as needed. / ppCommunicates claim activity and processing with the client; maintains professional client relationships. / ppEnsures claim files are properly documented and claims coding is correct. / ppRefers cases as appropriate to supervisor and management. / ppDelegates work and mentors assigned staff. / ppAdditional Functions and Responsibilities : / ppPerforms other duties as assigned. / ppSupports the organizations quality program(s). / ppQualifications : / ppEducation Licensing : / ppBachelors degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. / ppExperience : / ppSix (6) years of claims management experience or equivalent combination of education and experience required. / ppSkills Knowledge : / ppIn-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business / ppExcellent oral and written communication, including presentation skills / ppPC literate, including Microsoft Office products / ppAnalytical and interpretive skills / ppStrong organizational skills / ppExcellent negotiation skills / ppGood interpersonal skills / ppAbility to work in a team environment / ppAbility to meet or exceed Performance Competencies / ppWork Environment : / ppWhen applicable and appropriate, consideration will be given to reasonable accommodations. / ppMental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines / ppPhysical : Computer keyboarding, travel as required / ppAuditory / Visual : Hearing, vision and talking as required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. / p / div